Last week, the Federal Trade Commission (FTC) published a report titled “Pharmacy benefit managers: the powerful middlemen who inflate drug costs and put pressure on traditional pharmacies.” While I won’t go into the specific arguments the FTC made, the report does include a number of interesting statistics and charts about pharmacy benefit managers (PBMs). Below are some highlights.
First, PBMs do much more than just design formularies. Today they are highly integrated entities, with many of them directly owned by health plans.
PBM size has increased due to a series of consolidations over the past 25 years.
Market share of the three largest PBMs (CVS Caremark, Express Scripts (ESI), and OptumRx) increased from 70% to 79% of the PBM market.
Specialty pharmacy mail order is increasing as a percentage of PBM revenue relative to other channels.
In fact, PBM parent company revenues accounted for 22% of all U.S. national healthcare spending in 2023.
You can read the full report here.
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